Journal
FRONTIERS IN NEUROSCIENCE
Volume 15, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fnins.2021.642589
Keywords
magnetic resonance imaging; diabetic polyneuropathy; magnetic resonance neurography; diffusion tensor imaging; fractional anisotropy; diabetes; prediabetes
Categories
Funding
- German research council [SFB 1158]
- international Foundation for Research in paraplegia (IRP)
- German Research Foundation [SFB 1158, KU 3555/1-1]
- International Foundation for Research in Paraplegia
- Deutsches Zentrum fur Diabetesforschung (DZD) e.V.
- Medical Faculty of the University of Heidelberg
- Pfizer
- Dietmar Hopp foundation [23011228]
- German Research Foundation (DFG) [KU 3555/1-1]
- German Research Council (DFG) [SFB 1118, 1158]
- Novo Nordisk
- Codman
- Guerbet
- Bayer
- Novartis
- European Union
- Siemens
- Stryker
- HoffmannKlose foundation of Heidelberg University Hospital
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The study shows that the sciatic nerve's fractional anisotropy is a surrogate marker for functional and electrophysiological parameters of both upper and lower limbs in patients with diabetes and prediabetes, suggesting that nerve damage in these patients affects the entire peripheral nervous system rather than being limited to symptomatic limbs.
Background Nerve damage in diabetic neuropathy (DN) is assumed to begin in the distal legs with a subsequent progression to hands and arms at later stages. In contrast, recent studies have found that lower limb nerve lesions in DN predominate at the proximal sciatic nerve and that, in the upper limb, nerve functions can be impaired at early stages of DN. Materials and Methods In this prospective, single-center cross-sectional study, participants underwent diffusion-weighted 3 Tesla magnetic resonance neurography in order to calculate the sciatic nerve's fractional anisotropy (FA), a surrogate parameter for structural nerve integrity. Results were correlated with clinical and electrophysiological assessments of the lower limb and an examination of hand function derived from the Purdue Pegboard Test. Results Overall, 71 patients with diabetes, 11 patients with prediabetes and 25 age-matched control subjects took part in this study. In patients with diabetes, the sciatic nerve's FA showed positive correlations with tibial and peroneal nerve conduction velocities (r = 0.62; p < 0.001 and r = 0.56; p < 0.001, respectively), and tibial and peroneal nerve compound motor action potentials (r = 0.62; p < 0.001 and r = 0.63; p < 0.001, respectively). Moreover, the sciatic nerve's FA was correlated with the Pegboard Test results in patients with diabetes (r = 0.52; p < 0.001), prediabetes (r = 0.76; p < 0.001) and in controls (r = 0.79; p = 0.007). Conclusion This study is the first to show that the sciatic nerve's FA is a surrogate marker for functional and electrophysiological parameters of both upper and lower limbs in patients with diabetes and prediabetes, suggesting that nerve damage in these patients is not restricted to the level of the symptomatic limbs but rather affects the entire peripheral nervous system.
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